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C ity of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
Name: ~c+1/YPU'~r , J~~~al~ ~} ~~:~ ~/rG Date: ~~~"~9 Time: /~ ~o a.m./p.m.
°~ First Inspection ~ Second ~
~Address : ~ ~~..? ~a ..,3 .,~G ~ U ~ I y ,~?~~ { ~ _ ~Y l. ~(/E Own: A~ Rent: ~ Age of Home : ~ 1
Residential: l~
' Prior Lake, MN 55 ~~7,~ Phone: ~'6 ~~ D/~,e2 Non-Residential: D
A. ~ BASEMENT ~ Yes C~1'No SLTMP BA5KET ~` 0~ 1 ~ 2 d 3 ~
WATER IN BASKET Q Yes ~ No SUMP PUMP ~]'0 Q 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) D Yes E~-No CI5TERN ~ Yes L~-i~"o
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover will
break seal. 5kip to Part B of this form.)
Discharge Point
" at Inspection:
~ Laundry tub ~ 5anitary sewer ~ Outside
a Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
O Home came with system a Response to inspection program a Other
~ Water in basement ~ Previous system failed
B. ROOF LEADER5: C-~'Yes Q No
C. ' YARD DRAINS ~ Yes L~'1~To
BEAVER SYSTEM 17 Yes t~'l~o
and why
DISCHARGE: ~''~1ear ~ Away
WINDOW WELLS ~ Yes I~I~To
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall a Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
NOTES:
~ Spring Q Winter
~ Back ~ Side
SUMP PUMP SYSTEM: C~3' PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, cat1651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes Q'~No
Where is this location?
Thi~ area will ~eed to be fixed so the cle~ water discharges to the storm sewer system.
I Ir~pector: ~-~~~ ~~~~~ ,, Date: ~'~' y y - I
Resident: _ ---- ~.. -~-.- ~ -- . Date: _~- ~' - P 9
I Disc~aimer: This visual inspection is done with due diligence to find obvious clear water cross-connections I
and;=cloes not imulv the structure meets all Citv Codes.
White: Homeowner
Yellow: City
Pink: HRG